•Following mastectomy, alloplastic breast reconstruction is the most commonly used method in the U.S. However, more patients are electing for autologous reconstruction due to perceived superior cosmetic outcomes [1]

•Deep inferior epigastric (DIEP) flaps have largely replaced transverse rectus abdominus (TRAM) flap as the new gold standard for post-mastectomy autologous breast reconstruction [1].

•Compared to TRAM flaps, DIEP flaps are associated with shorter hospital stays, less postoperative pain, less donor site morbidity and are less costly [2-6].

•However, bulge or hernia occurs in up to 4-6% of DIEP flaps postoperatively [7-9].

•OBJECTIVE: The aim of this study is to investigate patient and operative risk factors for hernia and bulge development in DIEP flaps, as well as the effects of prophylactic mesh placement on these postoperative complications.